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NPI Code Detail

MEDICARE: CHERISH ANGELIC OBENZA CANDA PT

MEDICARE: CHERISH ANGELIC OBENZA CANDA PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 24493CA

General Provider Information

NPI Number : 1508875832
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERISH ANGELIC OBENZA CANDA PT
Provider Business Mailing Address
First Line : 4538 PEBBLE BEACH DR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-1909
Country : US
Telephone Number : 209-267-4419
Fax Number : 209-476-8747
Provider Business Practice Location Address
First Line : 5910 PACIFIC AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95207-4704
Country : US
Telephone Number : 209-475-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 04/22/2015

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